{"title":"Guidelines in Practice: Diagnosis and Management of Eosinophilic Esophagitis.","authors":"Evan S Dellon","doi":"10.14309/ajg.0000000000003386","DOIUrl":"10.14309/ajg.0000000000003386","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":"2223-2225"},"PeriodicalIF":7.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sung Won Chung, Ye-Jee Kim, Jihye Lim, Jonggi Choi, Danbi Lee, Ju Hyun Shim, Kang Mo Kim, Young-Suk Lim, Han Chu Lee, Sehee Kim, Won-Mook Choi
{"title":"Risk of Extrahepatic Malignancies in Patients With Autoimmune Hepatitis: A Nationwide Cohort Study.","authors":"Sung Won Chung, Ye-Jee Kim, Jihye Lim, Jonggi Choi, Danbi Lee, Ju Hyun Shim, Kang Mo Kim, Young-Suk Lim, Han Chu Lee, Sehee Kim, Won-Mook Choi","doi":"10.14309/ajg.0000000000003261","DOIUrl":"10.14309/ajg.0000000000003261","url":null,"abstract":"<p><strong>Introduction: </strong>Nationwide, population-based data on the risk of extrahepatic malignancy in patients with autoimmune hepatitis (AIH) in Asian countries are scarce. This study aimed to examine the risk of developing extrahepatic malignancies in a nationwide cohort of patients with AIH.</p><p><strong>Methods: </strong>Using claims data from the Korean National Health Insurance Service database, patients diagnosed with AIH between 2007 and 2019 (n = 7,382) were matched in a 1:8 ratio with an age- and sex-matched control population (n = 58,320). We compared the incidence rates and hazard ratios (HRs) of overall and specific extrahepatic malignancies between the 2 groups, while also examining the impact of immunosuppressant use.</p><p><strong>Results: </strong>During a median follow-up period of 5.2 years, a total of 3,713 extrahepatic malignancies developed. The incidence rate of extrahepatic malignancy in patients with AIH (990.8 cases per 100,000 person-years) was comparable with that in the matched controls (937.6 cases per 100,000 person-years), with an HR of 0.93 (95% confidence interval (CI), 0.81-1.07; P = 0.30). However, a significantly higher risk of hematologic malignancies, particularly lymphoma or myeloma (HR, 2.66; 95% CI, 1.70-4.17; P < 0.001), was observed. The use of glucocorticoids (HR, 0.74; 95% CI, 0.31-1.75; P = 0.50) or azathioprine (HR, 2.12; 95% CI, 0.90-5.02; P = 0.09) had no impact on the risk of lymphoma or myeloma in patients with AIH.</p><p><strong>Discussion: </strong>In this nationwide, population-based cohort, AIH was not associated with an increased risk of overall extrahepatic malignancy compared with age- and sex-matched controls. However, AIH itself increased the risk of lymphoma or myeloma, independent of immunosuppressant use.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":"2302-2311"},"PeriodicalIF":7.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142881059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lluís Mundet, Tennekoon Buddhika Karunaratne, Omar Ortega, Alba Raventós, Pere Clavé
{"title":"Study of the Corticoanorectal Neurophysiology in Women With Fecal Incontinence.","authors":"Lluís Mundet, Tennekoon Buddhika Karunaratne, Omar Ortega, Alba Raventós, Pere Clavé","doi":"10.14309/ajg.0000000000003295","DOIUrl":"10.14309/ajg.0000000000003295","url":null,"abstract":"<p><strong>Introduction: </strong>Fecal incontinence (FI) is a prevalent condition that disproportionately affects women. Although sphincter biomechanics are well studied, the integrity of the corticoanal motor pathway remains elusive. We evaluated the corticospinoanorectal pathway in women with FI against age-matched (AM-HV) and young healthy (Y-HV) volunteers.</p><p><strong>Methods: </strong>Observational study with 18 women with FI (mean age: 63.4 ± 11.1), 15 AM-HV (60.7 ± 9.01), and 15 Y-HV (24.2 ± 5.39) conducted in a tertiary hospital. Patients underwent clinical evaluation, high-resolution anorectal manometry, endoanal ultrasound, and transcranial/translumbosacral magnetic stimulation to assess anorectal motor-evoked potentials (MEP). Clinical severity was measured with St. Mark score and quality of life with Fecal Incontinence Quality of Life and EQ5D.</p><p><strong>Results: </strong>Patients had longer MEP latencies than AM-HV in the cortico-anal (25.93 ± 3.67 ms vs 22.89 ± 1.38 ms) and right lumbo-rectal segments (5.64 ± 1.35 ms vs 4.39 ± 1.27 ms; P < 0.05), but not in the tibial segment (control) (33.35 ± 2.88 ms vs 32.08 ± 2.05 ms; P > 0.05). However, tibial latencies were longer in AM-HV compared with Y-HV (32.08 ± 2.05 ms vs 29.21 ± 2.75 ms; P = 0.003). In FI, 41.1% had corticoanorectal impairments, 50% lumboanal, and 44.4% sacral. Overall, 82.4% showed delayed latencies in at least one of the 12 segments. High-resolution anorectal manometry revealed 83.24% had external anal sphincter dysfunction, 40% internal sphincter dysfunction, and 23.57% both. MEP latencies inversely correlated with external anal sphincter squeeze strength. FI patients had significantly poorer EQ5D scores compared with both control groups.</p><p><strong>Discussion: </strong>Women with FI show significant neuropathy in the corticospinoanorectal pathway linked to impaired anorectal function. These findings underscore the brain-gut axis's role in FI pathophysiology, advocating for advanced neurophysiological diagnostics and targeted interventions.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":"2382-2391"},"PeriodicalIF":7.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142942723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abraham Z Cheloff, Leah Kim, Mark B Pochapin, Aasma Shaukat, Violeta Popov
{"title":"Accuracy of Visual Estimation for Measuring Colonic Polyp Size: A Systematic Review and Meta-Analysis.","authors":"Abraham Z Cheloff, Leah Kim, Mark B Pochapin, Aasma Shaukat, Violeta Popov","doi":"10.14309/ajg.0000000000003391","DOIUrl":"10.14309/ajg.0000000000003391","url":null,"abstract":"<p><strong>Introduction: </strong>Measurement of colorectal polyps is typically performed through visual estimation, which is prone to bias. Studies have evaluated the accuracy of visual estimation and utility of assistive tools, but results have been mixed. The aim of this study was to clarify the accuracy of visual estimation as a measurement tool and the benefits of artificial intelligence.</p><p><strong>Methods: </strong>MEDLINE and Embase were searched through October 2024. Extraction and quality assessment were performed independently by 2 authors. The primary outcome was the pooled absolute mean difference in size between visual estimation and control. Secondary outcomes included subgroup analysis of expert vs trainee status, accuracy of artificial intelligence, study origin (East vs West), comparator type, definition of accuracy, polyp size, direction of estimation, and image type.</p><p><strong>Results: </strong>Thirty-five studies with 42,964 polyp measurements were included in our analysis. All studies were of high quality, and there was no evidence of publication bias. The pooled absolute mean difference from comparator was 1.68 mm (confidence interval 1.21-2.15) with high variability explained by differences in the comparator, direction of estimation, image type, and size of the polyp. Overall accuracy was 60% with high variability as well, with increased accuracy with video displayed over photographs. Artificial intelligence improved accuracy with an odds ratio of 7.46.</p><p><strong>Discussion: </strong>Visual estimation is an inaccurate and imprecise way to measure colorectal polyps. Further research is needed to determine the impact on clinical outcomes related to colorectal cancer. Investment in new technology to aid in polyp measurement is an important next step.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":"2251-2259"},"PeriodicalIF":7.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Response to Lai and Liao.","authors":"Andrew D Mosholder, Kira Leishear","doi":"10.14309/ajg.0000000000003444","DOIUrl":"10.14309/ajg.0000000000003444","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":"2457-2458"},"PeriodicalIF":7.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143963501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Bruce E Sands, David T Rubin, Edward V Loftus, Douglas C Wolf, Remo Panaccione, Jean-Frederic Colombel, Axel Dignass, Miguel Regueiro, Severine Vermeire, Anita Afzali, Garrett Lawlor, Harris A Ahmad, Hsiuanlin Wu, Mark T Osterman, Anjali Jain, Geert D'Haens
{"title":"Impact of Prior Biologic Exposure on Ozanimod Efficacy and Safety in the Phase 3 True North Clinical Trial.","authors":"Bruce E Sands, David T Rubin, Edward V Loftus, Douglas C Wolf, Remo Panaccione, Jean-Frederic Colombel, Axel Dignass, Miguel Regueiro, Severine Vermeire, Anita Afzali, Garrett Lawlor, Harris A Ahmad, Hsiuanlin Wu, Mark T Osterman, Anjali Jain, Geert D'Haens","doi":"10.14309/ajg.0000000000003310","DOIUrl":"10.14309/ajg.0000000000003310","url":null,"abstract":"<p><strong>Introduction: </strong>Patients with ulcerative colitis (UC) and prior biologic failure may have reduced or delayed efficacy with subsequent advanced therapies. This analysis evaluated the efficacy and safety of ozanimod during the True North (TN) study and its open-label extension (OLE) in biologic-exposed patients with UC.</p><p><strong>Methods: </strong>TN was a randomized, placebo-controlled 52-week trial (10-week induction, 42-week maintenance period). Eligible patients could enter the OLE. Clinical outcomes were assessed at TN week (W) 10 and W52 and OLE W46 and W94. Symptomatic efficacy was evaluated through induction and in the OLE until W94. Safety was assessed.</p><p><strong>Results: </strong>This analysis included 376 biologic-exposed patients. In the placebo-controlled cohort, more ozanimod-treated patients achieved clinical response than placebo at W10 regardless of the number or type of prior biologics; patients who used 1 vs ≥2 prior biologics achieved higher efficacy rates. Efficacy rates were higher at W52 than W10 and were similar across subgroups regardless of the number or type of prior biologics. Significantly greater proportions of ozanimod vs placebo patients achieved symptomatic response by W5 ( P = 0.0173) and symptomatic remission by W10 ( P = 0.0207). Among biologic-exposed TN W10 ozanimod nonresponders who entered the OLE, 61% achieved symptomatic response with an extra 10 weeks of ozanimod treatment. Ozanimod efficacy was durable for ∼3 years of continuous treatment in biologic-exposed W52 clinical responders who entered the OLE. No new safety signals were observed.</p><p><strong>Discussion: </strong>Ozanimod was effective and safe in biologic-exposed patients with UC, but these patients may require more time to respond to treatment. Clinical trial registry website and trial numbers: ClinicalTrials.gov , numbers NCT02435992 and NCT02531126.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":"2339-2349"},"PeriodicalIF":7.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12487659/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142942719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Michael J Langevin, Christopher D Jensen, Amy R Marks, Sophie A Merchant, Jessica Badalov, Jeffrey K Lee, Angela Y Lam, Ethan A Halm, Theodore R Levin
{"title":"Rebound in Fecal Testing, Colonoscopy Utilization, and Colorectal Neoplasia Detection During the COVID-19 Pandemic.","authors":"Michael J Langevin, Christopher D Jensen, Amy R Marks, Sophie A Merchant, Jessica Badalov, Jeffrey K Lee, Angela Y Lam, Ethan A Halm, Theodore R Levin","doi":"10.14309/ajg.0000000000003293","DOIUrl":"10.14309/ajg.0000000000003293","url":null,"abstract":"<p><strong>Introduction: </strong>The COVID-19 pandemic reduced colorectal cancer (CRC) screening, but the rebound in testing and outcomes after the pandemic has not been widely reported. We evaluated CRC test utilization and colorectal neoplasia detection among screening eligible patients in a large health system in 2020 and 2021, compared with 2019 (prepandemic).</p><p><strong>Methods: </strong>Using a retrospective cohort study design, fecal immunochemical test (FIT) and colonoscopy utilization, FIT positivity, and neoplasia detection were evaluated annually in 2019-2021 among Kaiser Permanente Northern California patients aged 50-75 years overall and by sex, age, race and ethnicity, and spoken language preference.</p><p><strong>Results: </strong>Compared with 2019, reductions in FIT, colonoscopy, FIT positivity, and neoplasia detection in 2020 were followed by a strong rebound in 2021 and no subgroups by age and sex or minority subgroups by race and ethnicity or spoken language preference demonstrably lagged in their recovery in 2021. Among White persons and those with an English language preference, there was a small lag in recovery to baseline levels. The overall decline in CRC testing by colonoscopy in 2020 was offset by a lesser decrease in FIT utilization in 2020, and a strong rebound in FIT utilization in 2021 helped to offset the small lag in the rebound in colonoscopies completed in 2021.</p><p><strong>Discussion: </strong>Findings may help guide organizations looking to improve CRC screening and minimize health care disparities related to national emergencies such as pandemics. Long-term studies are needed to evaluate how pandemic-related changes in CRC screening practices will affect future CRC outcomes.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":"2422-2431"},"PeriodicalIF":7.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12228842/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}